Civilian injuries of the rectum and anus

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Abstract
Cases (62) of injuries of the bowel between the sacral promontory and the anus are reviewed. These are divided into different anatomic types. Injuries above the peritoneal reflection can be intraperitoneal, retroperitoneal or both. Injuries between the peritoneal reflection and levator ani are subperitoneal. Injuries of the anal canal and sphincters are usually combined with injuries of the perineum, which can extend into or around the anal canal. Perforations can be complete or incomplete, intraluminal or extraluminal. These different injuries differ etiologically, pathologically and clinically. There is no best treatment for anorectal injuries. Subperitoneal and incomplete perforations can be treated conservatively and selected cases of intraperitoneal perforation can be treated with simple closure of perforation. In almost all other cases a diverting colostomy is combined with intraperitoneal or perineal drainage and, when feasible, closure of the perforation. When the perforation cannot be found at laparotomy, a diverting proximal colostomy is recommended, particularly in the presence of a bowel-wall hematoma or gross peritoneal contamination. Injuries of other organs must be treated appropriately. The morbidity and mortality from these anorectal injuries primarily depend on the associated injuries.

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